Basic Information
| Provider Information | |||||||||
| NPI: | 1982906020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | MISOOK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4545 POST OAK PLACE DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770273164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139608008 | ||||||||
| FaxNumber: | 7139600965 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 POST OAK PLACE DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770273164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139608008 | ||||||||
| FaxNumber: | 7139600965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 608758 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | DQ5280 | 01 | TX | MEDICARE RR PALMETTO | OTHER | 2823866-01 | 05 | TX | MEDICAID | P00947788 | 01 | TX | PALMETTO RR | OTHER | 0016SH | 01 | TX | BCBS OF TEXAS | OTHER | DO7564 | 01 | TX | RR PALMETTO | OTHER | 862N93 | 01 | TX | BCBS OF TEXAS | OTHER |